PROJECT SUMMARY/ABSTRACT Older adults are at increased risk of having multiple chronic conditions leading to an increased risk of hospitalization and decreased quality of life. Discontinuities in care make managing multiple conditions difficult and may lead to repeat hospitalizations. The NIH has called for clinical and economic research on aging related conditions, and to make health care higher quality, more accessible, equitable, and affordable. One strategy to increase continuity of care for those at increased risk of hospitalization is to provide the patient with access to a single physician who can care for them in both inpatient and outpatient settings. This innovative approach is referred to as the Comprehensive Care Physician (CCP) model. The randomized controlled trial of CCP (NCT01929005) is currently ongoing and initial results have found substantial reductions in hospitalizations for CCP participants. The critical next question is to determine how quality-of-life is impacted and CCP?s cost-effectiveness. The objective of this study is to estimate the effects of CCP care versus standard care on quality-adjusted life-years (QALYs), costs, and cost-effectiveness for older adults with varying degrees of elevated risk of hospitalization. It is hypothesized that CCP will increase quality of life and reduce costs of care through improved management and reduced hospitalizations. Two specific aims are proposed: to compare the effects of CCP compared to standard care on QALYs gained, costs, and cost-effectiveness for older adults (Aim 1), and to assess how the cost-effectiveness of CCP compared to standard care varies by risk of hospitalization (Aim 2). A cost-effectiveness analysis taking a Medicare perspective will be conducted over a two-year time-horizon. Costs are available from Medicare claims data, quality-of-life was measured using direct utility assessment, and incremental cost-effectiveness ratios will be estimated. Uncertainty will be explored through a range of sensitivity analyses. If CCP is found to be cost-effective, it could revolutionize care delivery in the US by improving health care outcomes, affordability, and efficiency. The training plan proposed, and the rich educational environment at the University of Chicago, will allow the applicant to develop technical and practical skills to establish an independent research program in the future.